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ENT
Ear Methods of Investigation
Built from Behrbohm — Ear, Nose and Throat Diseases with Head and Neck Surgery
What’s inside
7 sections · 101 slides
Overview
- What this deck teaches you
Inspection, Palpation, and Otoscopy
The bedside examination — look, feel, then look inside
- Step 1 — Inspecting the outer ear
- Step 2 — Palpation (feeling the ear)
- Otoscopy — looking down the ear canal
- Electric otoscope and video-otoscope
- Otomicroscopy of the ear
- Rigid telescope for otoendoscopy
- How to perform otoscopy safely
- Basic ear examination instruments
- Otoscopy technique in a child
- Clearing the canal for a clear view
- When NOT to syringe, and common mistakes
- What a normal eardrum looks like
- Pneumatic otoscope for testing eardrum mobility
- Signs of a diseased eardrum (1)
- Signs of a diseased eardrum (2)
Diagnostic Imaging
Seeing the bone and nerves the otoscope cannot reach
- Why the ear is hard to image
- Computed tomography (CT) — the bone detective
- CT of the temporal bone, axial view
- CT of the temporal bone, coronal views
- Angiography — imaging the blood vessels
- MRI — soft tissue and nerves
- MRI of the temporal bone with a small tumour
- Diffusion-weighted MRI — hunting hidden cholesteatoma
Function of the Eustachian Tube
Checking the ear's pressure-equalising valve
- Testing the eustachian tube
- A caution with the Valsalva manoeuvre
Hearing Investigations
From a simple tuning fork to objective, computer-recorded tests
- Testing hearing without a machine
- Tuning-fork tests — the Weber test
- The Weber test and its interpretation
- Tuning-fork tests — the Rinne test
- The Rinne test and its interpretation
- The Gellé test — ossicle mobility
- The Gellé test for ossicular mobility
- Interpreting the clinical hearing tests
- The physics behind audiometry
- Pure-tone audiometry
- A normal pure-tone audiogram
- The human auditory field
- Air conduction vs bone conduction
- Audiograms of conductive hearing loss
- Sensorineural hearing loss on the audiogram
- Audiograms of sensorineural hearing loss
- Recruitment — when soft is inaudible but loud hurts
- Fowler loudness-balance test
- Pathologic fatigue — a retrocochlear sign
- Speech audiometry — testing real understanding
- The speech field within the audiogram
- Speech audiometry curves
- Comparing pure-tone and speech results
- Objective hearing tests — no patient response needed
- Impedance audiometry and tympanometry
- Tympanometry set-up
- The four key tympanogram shapes
- The stapedial (acoustic) reflex
- Auditory evoked potentials (AEPs) — the idea
- Types of auditory evoked potential
- Auditory brainstem response waveform
- Auditory steady-state response (ASSR)
- Otoacoustic emissions (OAEs) — the cochlea sings back
- Types of otoacoustic emission
- Recording transient and distortion-product OAEs
- Screening hearing in babies — why and when
- Hearing tests used in infants and children
Vestibular Function Tests
Testing balance and the eye movements it controls
- How we test the balance system
- Vestibulospinal reflex tests — standing and stepping
- The Unterberger stepping test
- Static positional (arm) reactions
- Position for static positional testing
- Nystagmus — what it is and how we watch it
- Frenzel glasses for observing nystagmus
- Symbols for recording nystagmus and vertigo
- The principle of nystagmography
- Spontaneous nystagmus
- Classification of spontaneous nystagmus
- Non-pathologic nystagmus — do not be fooled
- Provoked nystagmus
- Provocation manoeuvres and the Dix-Hallpike test
- Static and dynamic positional testing
- Vestibular evoked myogenic potentials (VEMPs)
- Electrode placement for cVEMP recording
- Reflex pathway of the ocular VEMP
- The head impulse test (HIT)
- Principle of the head impulse test
- Experimental tests — turning and caloric
- Principle of the caloric labyrinthine test
- The fistula test and optokinetic tracking
- A positive fistula test from cholesteatoma erosion
Investigation of the Facial Nerve
Locating and grading a facial palsy
- Central versus peripheral facial palsy
- Tests that localise the lesion
- Three grades of nerve injury
- Electrical and magnetic excitability tests
- Key takeaways
- Why does the Weber test lateralise to the affected ear in conductive loss, but to the healthy ear in sensorineural loss?
- Ear, Nose, and Throat Diseases: With Head and Neck Surgery